Preoperative Factor Analysis For Prognosis Of Ruptured Middle Cerebral Artery M1 Bifurcation Aneurysm

Objective:To explore the factors influencing the prognosis of carotid clip-off for Ml bifurcation aneurysms in the middle cerebral artery before surgery,so as to provide a reference for the preoperative assessment of surgical risk and prediction of patient outcome.Method:The preoperative clinical datum of 59 patients,with ruptured M1 bifurcation-type middle cerebral artery aneurysms and undergone aneurysm neck clipping by the Affiliated hospital of Yangzhou university from March 2013 to August 2018,were retrospectively analyzed.Preoperative evaluation indicators include:age,gender,basic diseases,Hunt-Hess classification,improved Fisher score,presence of concurrent hematoma,midline structure shift,aneurysm side,size,shape of aneurysms neck,length of bifurcation,the angle of middle cerebral artery M1 bifurcation and vertical axis,the angle of the middle cerebral artery bifurcation,middle cerebral artery M1 bifurcation diameter change rate.Discharge and follow-up were assessed on Glasgow outcome scale(GOS):good prognosis(5 points),moderate disability(4 points),severe disability(3 points),vegetative state(2 points),and death(1 point).According to the postoperative independent living ability,GOS score of 5-4 indicates a satisfactory prognosis,and GOS score of 3-1 indicates an unsatisfactory prognosis.SPSS 19.0 statistical software was used to perform statistical analysis for each single factor(All variables were tested independently using a chi-square analysis and t-test for normal distributed data,and Wilcoxon rank-sum test for non-normal distributed data).A P value<0.05 for a 95%confidence interval(CI)was considered statistically significant.A multivariate analysis was then performed using a binary logistic regression analysisResult:In this study,59 cases of ruptured middle cerebral artery M1 bifurcation aneurysm and performed aneurysm clipping were analyzed,with a satisfactory prognosis in 48 cases(81.3%)and an unsatisfactory prognosis in 11 cases(18.7%).According to statistical analysis,Hunt-Hess classification,improved Fisher score,hematoma,midline structure shift,the length of the middle cerebral artery M1 bifurcation,the rate of vascular diameter change of the middle cerebral artery M1 bifurcation were considered statistically significant(P<0.05).The correlation factors were further analyzed by a binary logistic regression analysis,and the results suggested that Hunt-Hess grading(P=0.033)and the rate of change of vascular diameter in the middle cerebral artery M1 bifurcation(P=0.043)were significant correlation factors.However,age,gender,basic disease,side of aneurysm,aneurysm size,shape of aneurysm neck,the angle of middle cerebral artery Ml bifurcation and vertical axis,angle of middle eerebral artery M1 bifurcation were not significantly correlated with prognosis.Conclusion:Hunt-hess grade and the rate of change of the inner diameter of the anterior segment of M1 bifurcation of the middle cerebral artery are significant risk factors for the prognosis of aneurysm clipping.In addition to improved Fisher score,hematoma status and deviation of midline structure and other commonly used clinical assessment factors,partial anatomical characteristics of parental artery are also associated with prognosis.A comprehensive and systematic analysis of risk factors can improve the accuracy of surgical prognosis assessment and provide certain reference value for subsequent treatment.